The future is urban: integrated planning policies can enable healthy and sustainable cities
Authors: Deepti Adlakha, Felix John
Journal: The Lancet Global Health (2022)

The world's urban population has increased drastically during the last century. At the turn of the 20th century, approximately 10% of people lived in cities. By 1950, the world's urban population had grown to 29%.1UN Department of Economic and Social Affairs2018 revision of the world urbanization prospects.https://population.un.org/wup/publications/Files/WUP2018-Methodology.pdfDate: 2018Date accessed: April 1, 2022Google Scholar Today, more than half of the world's population resides in cities. By 2050, it is expected that at least two-thirds of the world's population, or nearly 7 of 10 people, will live in cities.2World BankUrban Development Overview.https://www.worldbank.org/en/topic/urbandevelopment/overview#1Date: 2020Date accessed: April 3, 2022Google Scholar The largest share of this tremendous urban growth will occur in low-income and middle-income countries (LMICs), in cities already carrying a disproportionate share of the global disease burden. This accelerating pace of urbanisation has exposed the fragile ecological future of our cities. Cities are engines of innovation and economic growth, but many fail to make progress on economic, environmental, societal, and health targets. Urban policies actively shape how people live and move around in cities. Policies determine the form and function of our neighbourhoods and thus the exposures and lifestyles of urban dwellers.3Stevenson M Thompson J de Sá TH et al.Land use, transport, and population health: estimating the health benefits of compact cities.Lancet. 2016; 388: 2925-2935Summary Full Text Full Text PDF PubMed Scopus (263) Google Scholar Current planning policies exacerbate urban inequities, creating cities that are spatially fragmented, socially divisive, and detrimental to health. Traffic exposure, noise and air pollution, social isolation, low physical activity, and sedentary behaviours are fuelling global epidemics of injuries and chronic diseases.4Giles-Corti B Vernez-Moudon A Reis R et al.(2016). City planning and population health: a global challenge.Lancet. 2016; 388: 2912-2924Summary Full Text Full Text PDF PubMed Scopus (532) Google Scholar City planning is known to influence physical activity and other health determinants.5Rydin Y Bleahu A Davies M et al.Shaping cities for health: complexity and the planning of urban environments in the 21st century.Lancet. 2012; 379: 2079-2108Summary Full Text Full Text PDF PubMed Scopus (444) Google Scholar Designing compact, high-density, pedestrian-friendly and cycling-friendly cities with accessible green spaces that enable sustainable mobility and active lifestyles is crucial for public health and the environment.6Nieuwenhuijsen MJ Urban and transport planning pathways to carbon neutral, liveable and healthy cities; a review of the current evidence.Environment International. 2020; 140105661 Crossref PubMed Scopus (81) Google Scholar These priorities are wholly consistent with the UN Sustainable Development Goals and targets set by WHO and UN-Habitat.7UNTransforming our world: the 2030 agenda for sustainable development.https://sdgs.un.org/sites/default/files/publications/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdfDate: 2015Date accessed: March 25, 2022Google Scholar, 8WHOUrban health initiative a model process for catalysing change.https://www.who.int/publications/i/item/WHO-HEP-ECH-AQH-2021-1Date: 2021Date accessed: March 20, 2022Google Scholar However, many city governments do not have sufficient data to implement policies and monitor their progress towards achieving these targets. This problem is most acute in LMICs in which policy makers have low access to tools to consider health and sustainability when formulating urban policies.9Smit W Hancock T Kumaresen J Santos-Burgoa C Meneses RSK Friel S Toward a research and action agenda on urban planning/design and health equity in cities in low and middle-income countries.J Urban Health. 2011; 88: 875-885Crossref PubMed Scopus (34) Google Scholar Governments in LMICs generally do not have the requisite financial resources to generate locally relevant data, conduct statistical analyses, develop and implement policies, track performance, facilitate stakeholder engagement, and build capacity to strengthen management and governance. In many LMICs, planning policies have ignored the large numbers of people living in informal settlements. Rampant, poorly managed, ad-hoc urban growth, population displacement, poor public health infrastructure, and land-grabbing have fuelled inequities in urban areas. The Lancet Global Health Series on urban design, transport, and health goes beyond describing why societies need to transition to healthier, more sustainable cities and focuses on the critical questions of how and what can be done to enable this process. It offers a roadmap for city leaders to act quickly, plan for future urban growth, and provide equitable infrastructure, services, and amenities. Integrated planning policies are essential for LMICs that have informal settlements, poor planning, weak infrastructure, and a paucity of basic services. The Series presents a rigorous, cross-sectoral, and scalable global framework with standardised methods for benchmarking and monitoring integrated city planning policies. The methods described convert spatial data into usable formats by making the maps and results available to policy makers, practitioners, and the community for real-world implementation. This Series provides a proof of concept for the real-world application of integrated city planning policies to harness economic, environmental, social, and health benefits for all. The authors address the data challenges of creating comparable global indicators and the importance of facilitating research translation. Using the proposed framework, city leaders and stakeholders can champion specific policies and development commitments at the local, national, and international scales to ensure an urban future that is healthy, sustainable, and equitable. An example is the global network of Bicycle Mayors promoted by the Amsterdam-based global non-governmental organisation, BYCS.10BYCSBicycle Mayor Network.https://bycs.org/our-work/bicycle-mayor/Date: 2016Date accessed: April 5, 2022Google Scholar BYCS is guided by the belief that bicycles transform cities and cities transform the world. Bicycle Mayors act as a social bridge to establish relationships between citizens, stakeholders, and political leaders. They help to make cycling accessible to the average person and bring it into the urban policy agenda. To provide equal opportunity to their citizens, elected officials and policymakers need to align better city planning policies with societal goals, public health, and environmental sustainability. Integrated cross-sectoral policies are essential to creating economic, environmental, and social benefits for all. We encourage government leaders and the wide range of relevant civil society groups to incorporate the tools developed for this Series into their daily work and plans for the future. Specifically, we call on global leaders and stakeholders to take collective action by implementing integrated planning policies to promote healthy and sustainable cities. We declare no competing interests. City planning policies to support health and sustainability: an international comparison of policy indicators for 25 citiesCity planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Full-Text PDF Open AccessUsing open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable citiesBenchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. Full-Text PDF Open AccessWhat next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policyThis Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Full-Text PDF Open AccessDetermining thresholds for spatial urban design and transport features that support walking to create healthy and sustainable cities: findings from the IPEN Adult studyAn essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probability of engaging in any walking for transport and WHO's target of at least 15% relative reduction in insufficient physical activity through walking. The International Physical Activity and the Environment Network Adult (known as IPEN) study (N=11 615; 14 cities across ten countries) provided data on local urban design and transport features linked to walking. Full-Text PDF Open Access